Irritable bowel syndrome

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

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Última revisión: 22 Aug 2025

Última actualización: 01 Nov 2023

Irritable bowel syndrome symptoms include recurrent abdominal pain or discomfort that is associated with a change in stool frequency or form. The pain or discomfort may be relieved by defecation.

It is important to determine whether there are any potential precipitating dietary associations such as caffeine, lactose-containing foods, or fructose-containing foods.

Examination of the abdomen is usually unremarkable. There may be mild and poorly localized tenderness in the right lower quadrant and/or left lower quadrant.

The diagnosis is based on the patient's history; there are no specific diagnostic tests. If the patient has worrying symptoms or findings such as anemia, weight loss, or fever, then these require thorough investigation.

Treatment should be individualized and is dependent on the patient's predominant symptoms.

Definición

Irritable bowel syndrome (IBS) is a chronic condition characterized by abdominal pain associated with bowel dysfunction. The pain is often relieved by defecation and is sometimes accompanied by abdominal bloating. There are no structural abnormalities to explain the pain. IBS occurs in about 15% of the adult population. The etiology is probably multifactorial, and evidence suggests motility, inflammatory, genetic, immune, psychological, and dietary components.[1]

Anamnesis y examen

Principales factores de diagnóstico

abdominal pain
alteration of bowel habits associated with pain
abdominal bloating or distension
normal exam of abdomen

Todos los datos

Otros factores de diagnóstico

passage of mucus with stool
urgency of defecation

Todos los datos

Factores de riesgo

physical and sexual abuse
posttraumatic stress disorder (PTSD)
age <50 years
female sex
previous enteric infection
family history
family and job stress

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Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Todos los datos

Pruebas diagnósticas que deben considerarse

fecal occult blood test
quantitative fecal immunochemical test (FIT)
serologic tests for celiac disease
fecal calprotectin
fecal lactoferrin
serum C-reactive protein (CRP)
erythrocyte sedimentation rate (ESR)
serum fibroblast growth factor 19
23‐seleno‐25‐homotaurocholic acid (SeHCAT) test
48-hour stool collection for total bile acids
empiric trial of bile acid binder
hydrogen/methane breath test
stool tests for Giardia lamblia
plain abdominal radiograph
colonoscopy
flexible sigmoidoscopy

Todos los datos

Algoritmo de tratamiento

En curso

constipation-predominant

diarrhea-predominant

alternating constipation and diarrhea

Colaboradores

Autores

Ned Snyder, MD, MACP, AGAF

Professor of Medicine

Baylor College of Medicine and Marion DeBakey VA Hospital

Houston

Adjunct Professor of Medicine

University of Texas Medical Branch

Galveston

Divulgaciones

NS declares that he is a member on the board of the Kelsey Research Foundation, a non-profit organization. Kelsey Research Foundation has received and awarded private grants for the study of the microbiome in several diseases, including irritable bowel syndrome.

Revisores por pares

Douglas Drossman, MD

Professor of Medicine and Psychiatry

School of Medicine

Co-Director

UNC Center for Functional GI and Motility Disorders

Chapel Hill

Divulgaciones

DD declares that he has no competing interests.

Simon McLaughlin, MBBS

Research Fellow

Department of Gastroenterology

St Mark's Hospital

Northwick Park

Harrow

Divulgaciones

SM declares that he has no competing interests.

Horace Williams, MBBS

Clinical Research Fellow

Division of Medicine

Imperial College

London

Divulgaciones

HW declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006 Apr;130(5):1480-91.Texto completo Resumen

Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021 Jan 1;116(1):17-44.Texto completo Resumen

Smalley W, Falck-Ytter C, Carrasco-Labra A, et al. AGA clinical practice guidelines on the laboratory evaluation of functional diarrhea and diarrhea-predominant irritable bowel syndrome in adults (IBS-D). Gastroenterology. 2019 Sep;157(3):851-4.Texto completo Resumen

Chey WD, Hashash JG, Manning L, et al. AGA clinical practice update on the role of diet in irritable bowel syndrome: expert review. Gastroenterology. 2022 May;162(6):1737-45.e5.Texto completo Resumen

Dionne J, Ford AC, Yuan Y, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol. 2018 Sep;113(9):1290-300. Resumen

Chang L, Sultan S, Lembo A, et al. AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation. Gastroenterology. 2022 Jul;163(1):118-36.Texto completo Resumen

Lembo A, Sultan S, Chang L, et al. AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with diarrhea. Gastroenterology. 2022 Jul;163(1):137-51.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Crohn disease
- Ulcerative colitis
- Microscopic colitis
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Guías de práctica clínica
- Probiotics and prebiotics
- AGA clinical practice update on the role of diet in irritable bowel syndrome: expert review
Más Guías de práctica clínica
Folletos para el paciente
Irritable bowel syndrome: what is it?
Irritable bowel syndrome: what are the treatment options?
Más Folletos para el paciente
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Irritable bowel syndrome

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

constipation-predominant

diarrhea-predominant

alternating constipation and diarrhea

Colaboradores

Autores

Ned Snyder, MD, MACP, AGAF

Divulgaciones

Revisores por pares

Douglas Drossman, MD

Divulgaciones

Simon McLaughlin, MBBS

Divulgaciones

Horace Williams, MBBS

Divulgaciones

Peer reviewer acknowledgements

Disclosures

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice